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Uganda Assessment Report

Ministry of Health

THE REPUBLIC OF UGANDA

Protect Promote Support Breastfeeding IBFAN UGANDA

October 2015

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Uganda Country Report 2015

International Baby Food Action Network (IBFAN) Asia BP-33, Pitam Pura, Delhi-110034, India

Phone: 91-11-27343608, 42683059 Fax : 91-11-27343606,

E-mail: [email protected] , [email protected]

Website : www.worldbreastfeedingtrends.org

Protect Promote Support Breastfeeding IBFAN UGANDA

Ministry of Health

THE REPUBLIC OF UGANDA

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The World Breastfeeding Trends

Initiative (WBTi)

Uganda

2015

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AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

This report is product of a consultative process and would not have been possible without the contribution of the

following individuals and Organisations.

The Ministry of Education, Sports, Science and Technology; the Ministry of Gender, Labour and Social Development; the

Ministry of Agriculture, Animal Industry and Fisheries; Office of the Prime Minister; the Health Pre-service training

institutions including Makerere University Medical School, Mulago Nurses and Midwives College for their technical

input and providing source documents.

The United Nations agencies; WHO, UNICEF and WFP are acknowledged for providing source documents and their

technical input into the process.

Members of the Technical Working Group; Dr. Gelasius K. Mukasa, Dr. Jacent Asiimwe, Ms Samalie Namukose, Musisi

John, Onyango Gerald, Grace Nambuusi and Mateeba Tim for conducting the entire exercise right from planning to

production of the report.

Members from the various Nutrition Stakeholder agencies and organisations who participated and provided input that

led to the finalization process of this report as reflected in the annex.

The Ministry of Health appreciates the financial support from IBFAN Africa without which this exercise of conducting

the World Breastfeeding Trends Initiative (WBTi) 2015 would not have been possible.

IBFAN Uganda is similarly acknowledged for their technical support to this exercise right from planning to production

of the report.

Dr. Jane Ruth Aceng

Director General Health Services

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Table of ContentsTable of ContentsTable of ContentsTable of Contents

Acknowledgements..................................................................................................................... iii

Table of Contents ........................................................................................................................ iv

List of Tables ................................................................................................................................ v

Executive Summary ..................................................................................................................... vi

Acronyms.................................................................................................................................. viii

1.0 Introduction ..................................................................................................................... 1

1.1 Justification ............................................................................................................................. 1

1.2 Goal ......................................................................................................................................... 2

1.3 Objectives ................................................................................................................................ 2

2.0 Methodology .................................................................................................................... 3

2.1 Process .................................................................................................................................... 3

2.2 WBTi methodology .................................................................................................................. 3

2.3 WBTi indicators ....................................................................................................................... 3

2.3.1 Part I: IYCF Policies and Programmes .............................................................................. 3

2.3.2 Part 2: Infant and Young Child Feeding Practices ............................................................ 4

3.0 Assessment Findings ......................................................................................................... 6

Part 1: IYCF Policies and Programs Indicators ................................................................................... 7

Indicator 1: National Policy, Programme and Coordination ...................................................... 7

Indicator 2: Baby Friendly Care and Baby-Friendly Hospital Initiative (16 Requirements to

Successful Infant and Young Child Feeding) .................................................................................. 9

Indicator 3: Implementation of the International Code of Marketing of Breastmilk

Substitutes (National Regulations on Marketing of Infant and Young Child Foods) ................... 12

Indicator 4: Maternity Protection ............................................................................................ 14

Indicator 5: Health and Nutrition Care Systems (in support of breastfeeding & IYCF) ........... 16

Indicator 6: Mother Support and Community Outreach - Community-based support for the

pregnant and breastfeeding mother ........................................................................................... 18

Indicator 7: Information Support ............................................................................................. 20

Indicator 8: Infant Feeding and HIV ......................................................................................... 22

Indicator 9: Infant and Young Child Feeding during Emergencies .......................................... 24

Indicator 10: Mechanisms of Monitoring and Evaluation System .......................................... 26

Part II: IYCF Practices Indicators ................................................................................................ 28

Indicator 11: Early Initiation of Breastfeeding ........................................................................ 28

Indicator 12: Exclusive Breastfeeding for the First Six Months ............................................... 29

Indicator 13: Median Duration of Breastfeeding .................................................................... 30

Indicator 14: Bottle feeding ..................................................................................................... 31

Indicator 15: Complementary feeding - Introduction of solid, semi-solid or soft foods ........ 32

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List of List of List of List of TablesTablesTablesTables

Table 1: IYCF Policies and Programmes Indicators ....................................................................... 4

Table 2: Infant and Young Child Feeding (IYCF) Practices Indicators ................................... 5

Table 3: WBTi Guidelines Scores, Colour rating and Grading the IYCF Policies and

Programmes ................................................................................................................................................ 5

Summary Part I: IYCF Policies and Programmes ................................................................................ 33

IBFAN Asia Guidelines for WBTi ................................................................................................... 33

Summary Part II: Infant and young child feeding (IYCF) practices .................................................... 34

IBFAN Asia Guidelines for WBTi ................................................................................................... 34

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Executive SummaryExecutive SummaryExecutive SummaryExecutive Summary

This assessment report 2015 highlights the state of implementation of the Global Strategy for Infant

and Young Child Feeding in Uganda, and accomplished under the World Breastfeeding Trends

Initiative (WBTi) of IBFAN Asia. It is a reassessment that has been conducted following a similar

assessment conducted in 2008 and 2012.

The Ministry of Health Uganda in collaboration with IBFAN Uganda jointly coordinated this

assessment. The report has been developed after a detailed study and analysis of existing policy and

programme documentation. The process was highly consultative with key nutrition stake holders

and several key documents were reviewed to obtain the require information. From the assessment

findings, Uganda scored 95.0 out of total of 150 and was classified in the BLUE category according to

the WBTi coding.

Assessment findings were discussed by Nutrition Stakeholders and consensus was reached on the

existing gaps and recommendations for addressing them. The table below summarises the

perfornmance of the two sets of indicators related to policy and programmes, and feeding practices

and compares results from the three assessments.

Part I: IYCF Polices and Programmes

Indicator Score (Out of 10)

2008 2012 2015

1. National Policy, Programme and Coordination 7.5 8.0 5.0

2. Baby Friendly Health Facility Initiative 2.5 6.0 4.0

3. Implementation of the International Code of Marketing

of Breastmilk Substitutes 8 8 7.5

4. Maternity Protection 1.5 1.5 3.5

5. Health and Nutrition Care System 5.5 7 6

6. Mother Support and Community Outreach 4 5 6

7. Information Support 6 6 5

8. Infant Feeding and HIV 8 9 9

9. Infant Feeding during Emergencies 4 2 7

10. Monitoring and Evaluation 4 6 6

Score Part 2 (Total) 51/100 58.5/100 59.0/100

Part 2: Infant and Young Child Feeding (IYCF) Practices

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IYCF Practice 2008 2012 2015

Result Score Result Score Result Score

Indicator 11 Starting Breastfeeding (Initiation) 42% 6 52.5% 9 52.5% 9

Indicator 12 Exclusive Breastfeeding for first 6

months 60.1% 9 63% 9 63% 9

Indicator 13 Median Duration of Breastfeeding 20.4 months 6 19 months 6 19 months 6

Indicator 14 Bottle-Feeding 11.4% 6 15.3% 6 15.3% 6

Indicator 15 Complementary Feeding 77.3% 6 68% 6 68% 6

Score Part 1 (Total) 33/50 36/50 36/50

2008 2012 2015

Total (Part 1 and Part 2) 84/150 94.5/150 95/150

There was slight improvement in performance from 94.5 in 2012 to 95 in 2015.This may be attributed to a revision of the

WBTi tool which provided for a more rigorous assessment in 2015. Details of the performance on each indicator, gaps

and recommendations are highlighted in the report. The gaps and recommendations will be the basis for the

development of a comprehensive work plan on Maternal Infant and Young Child Feeding.

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AcronymAcronymAcronymAcronymssss

AIDS Acquired Immune Deficiency Syndrome

APPAR Asia Pacific Participatory Action Research

ARVs Antiretrovirals

BFHI Baby Friendly Health Facility Initiative

BMI Body Mass Index

CSS Child Survival Strategy

EID Early Infant Diagnosis

FAO Food and Agricultural Oraganisation

GAIN Global Alliance on Nutrition

GBICS The Global Breastfeeding Initiative For Child Survival

GLOPAR Global Participatory Action Research

HBB+ Helping Babies Breathe Plus

HCT HIV Counselling and Testing

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HSSP Health Sector Strategic Plan

IBFAN International Baby Food Action Network

IEC Information, Education and Communication

IFE Infant Feeding in Emergencies

ILO International Labor Organization

IMAM Integrated Management of Acute Malnutrition

IYCF Infant and Young Child Feeding

MDGs Millenium Development Goals

MIS Management Information System

MIYCF Maternal Infant and Young Child Feeding

MHN Mental Health Nursing

MOGLSD Ministry of Gender Labour and Social Development

MoH Ministry of Health

MPC Maternity Protection Convention

MSG Mother Support Group

NACS Nutrition Assessment, Counseling and Support

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NCDs Non Communicable Diseases

NGOs Non Governmental Organisations

NOTU National Organisation of Trade Unions

OPD Out Patient Department

PD Positive Deviance

PIF Powdered Infant Formula

PIHTC Provider Initiated HIV Testing and Counselling

PMTCT Prevention of Mother to Child Transmission of HIV/AIDS

SDGs Sustainable Development Goals

TAM Tracking and Monitoring

UDHS Uganda Demographic and Health Survey

UN United Nations

UNICEF United Nations Children Fund

VCCT Voluntary and Confidential Counseling and Testing

VHT Village Health Team

WABA World Alliance of Breastfeeding Associations

WBTi World Breastfeeding Trends Initiatives

WFP World Food Programme

WHA World Health Assembly

WHO World Health Organization

YCC Young Child Clinic

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1.01.01.01.0 IntroductionIntroductionIntroductionIntroduction

Uganda suffers from the double burden of malnutrition, both undernutrition (stunting, underweight,

wasting and micronutrient deficiencies) and over nutrition (overweight/obesity). Malnutrition is high

among children under age 5: 33% are stunted, 4.8% are wasted, 16% are underweight, 49% are

anaemic, 38% are Vitamin A Deficient, 10.2 % are born with low birth weight, 3% are

obese/overweight (UDHS, 2011). Vulnerability to stunting varies from region to region; stunting is

much higher in rural areas with 18.65 stunted in the urban areas compared to the 35.6% stunted in

the rural areas. Similarly, women’s nutritional status has worsened over the years: 12% of women

aged 15-49 years are undernourished (BMI <18.5) and 19% are overweight/obese (BMI ≥25).

Optimal Maternal, Infant and Young Child feeding (MIYCF) is increasingly recognized as one of the

most effective interventions for reducing maternal and infant mortality. Although Uganda has a

strong breastfeeding culture, 40% of the children under 6 months of age have not been exclusively

breastfed and only 52.5% were breastfed within an hour of birth, 41.1% were given prelacteal feeds.

Compared to the UDHS of 2006, 15% was bottlefed. Regarding timely and appropriate feeding, 24%

of Ugandan children aged 6 – 24 months met the minimum standards.

In effort to address the high burden of malnutrition in the country, the government has put in place

various policies and programs to create an enabling environment to support, promote and protect

optimal MIYCF. Detailed policies and strategies will be highlighted during the assessment of the

various indicators below. Capacity building efforts have been put in place to ensure that service

providers acquire the necessary knowledge and skills to support optimal MIYCF. Mainstreaming

MIYCF into the various sector ministries is being undertaken but needs further strengthening.

A situation analysis (WBTi assessment) was done in Uganda by Ministry of Health in collaboration

with IBFAN Uganda in 2008 and 2012, gaps were identified and recommendations made to help

improve on the performance. Since then, Uganda has been implementing IYCF interventions,

however, progress on recommendations from the previous assessments has not been documented.

It is against this background that the Ministry of Health in collaboration with IBFAN Uganda

conducted this assessment to evaluate the current situation on policies, programmes and practices

related to maternal, infant and young child feeding. The findings from the assessment will be used to

finalise the draft MIYCF roadmap taking into consideration post MDGs and Sustainable

Development Goals (SDGs).

1.1 Justification

The Global Strategy calls for urgent action by all member states to develop, monitor and evaluate a

comprehensive policy and a plan of action on infant and young child feeding to achieve reduction in

child malnutrition and mortality. The WHA further adopted Resolution 58.32 in May 2005 that calls

on Member States to assure resources for plans of action for improving infant and young child

feeding practices.

The WBTi assessments for 2008 rated Uganda yellow (84/150) while in 2012 Uganda was rated

blue (94.5/150), which showed a slight improvement in performance. It was deemed necessary to

conduct the WBTi reassessment because three years have elapsed since the last assessment was

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done. The WBTi model will help us track, assess, and monitor our performance in relation to the

Global Strategy and the findings will be used to develop a comprehensive plan for implementation,

monitoring and evaluation of MIYCF.

1.2 Goal

This situation analysis was carried out so as to provide guidance to the country in understanding

the current gaps to help government, donors, bilaterals, and UN agencies to commit resources

where they are most needed. It will help NGOs to define areas for advocacy and thus focus their

efforts. It will also help to effectively target strategies that can improve maternal, infant and young

child nutrition.

1.3 Objectives

The overall objective was to conduct a situational analysis and provide information for planning and

implementation of MIYCF activities.

Specific Objectives of the WBTi assessment were to:

1. Review current policies, plans, activities by sector ministries, donors, institutions, government, bilaterals, UN agencies whether they address MIYCF

2. Analyse and compile the findings on implementation of MIYCF

3. Share the WBTi findings with key stakeholders

4. Publish the report of the assessment.

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2.02.02.02.0 MethodologyMethodologyMethodologyMethodology

2.1 Process

A core group of 7 persons, including representatives from the Government and IBFAN Uganda was

identified. During the first meeting of the identified key persons, an orientation was done by one of

the core group members who had undertaken an international training course on WBTi. During

the orientation, data sources were identified per indicator. A consensus was reached on roles and

responsibilities of the team members regarding data collection on the 15 indicators. Data collection

on indicators 1, 2 and 3 was to be undertaken collectively. Core team members were given letters

of introduction from the Ministry of Health to access the required information from the identified

data sources. The core team then held meetings to compile and rate the country performance on

the various indicators.

2.2 WBTi methodology

The WBTi monitoring and evaluation tool initiated in Asia was used. This tool uses the

methodology and philosophy of Global Participatory Action Research (GLOPAR)1993 developed by

the World Alliance for Breastfeeding Action (WABA) to track targets set by the Innocenti

Declaration of 1990. WBTi also adopted the WHO (2003) monitoring and evaluation tool on Infant

and Young Child Feeding for assessing national practices, policies and programmes.

2.3 WBTi indicators

The WBTi is based on a wide range of indicators, which provide an impartial global view of key

factors. The WBTi identified 15 indicators which were divided into two parts: Part I, IYCF Policies

and Programmes and Part II deals with Infant and Young Child Feeding Practices. Each indicator has

its specific significance.

2.3.1 Part I: IYCF Policies and Programmes

Part I deals with policy and programmes and has 10 indicators (Table 1). The description of

indicators begins with a key question and its background and it is followed by a result that is given

in the table format which depicts a subset of questions that have been answered using the available

information, documentation and sometimes observations. Another column shows the relevant

result checked in the column opposite the subset of questions. This result is then scored and rated

according to the 2014 updated WBTi guidelines. Each indicator has a maximum score of ten.

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Table 1: IYCF Policies and Programmes Indicators

No Indicator

1. National Policy, Programme and Coordination

2. Baby Friendly Health Facility Initiative (Sixteen Requirements to

Successful Infant and Young Child Feeding)

3. Implementation of the International Code (Regulations on Marketing

of Infant and Young Child Foods)

4. Maternity Protection

5. Health and Nutrition Care

6. Community Outreach

7. Information Support

8. Infant Feeding and HIV

9. Infant Feeding During Emergencies

10. Monitoring and Evaluation

Some subsets of questions are subjective in nature and were answered using available information

and consensus among the core group. The achievement is given a tick in the results column. Total

score of each indicator is given at the end of the table and the areas where gaps have been found

and recommendations to bridge them identified for discussion with the stakeholders. The sources

of these findings are then provided at the end of the Part-II findings. Summary comments in the end

provide other relevant information and progress on these indicators.

2.3.2 Part 2: Infant and Young Child Feeding Practices

Part-2 has 5 indicators, based on the WHO tool and deals with infant feeding practices. The five

indicators (1-5) are dealt with separately (Table 2). In the description of each indicator, there is a

key question addressing the indicator itself followed by its background. Then the result of the

indicator is expressed in numeric value, with percentage along with a graph. Thereafter, the rating

and grading system is as per WBTi guidelines. The indicator results are given in the first column, the

WHO’s key to rating and WBTi guidelines in the next column. WBTi tool kit helps to provide this

scoring as well as color rating and grading. Source of this result, year and its scope has been

mentioned. Summary comment is given in end of each 11-15 indicator, which provides its progress,

as well as any other important related information.

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Table 2: Infant and Young Child Feeding (IYCF) Practices Indicators

No Indicator

11 Percentage of babies breastfed within one hour of birth

12 Percentage of babies 0<6 months of age exclusively breastfed in the last 24 hours

13 Babies are breastfed for a median duration of how many months

14 Percentage of breastfed babies less than 6 months old receiving other foods or

drink from bottles

15 Percentage of breastfed babies receiving complementary foods at 6-9monthsof age

A set of criteria has been developed for each target based on the Innocenti Declaration and

beyond, i.e. considering most of the targets of the Global Strategy. For each indicator, there is a

subset of questions leading to key achievement, indicating how Uganda is doing in a particular area.

Each question had a possible score of 0-3 and the indicator had a maximum score of 10. Once

information about the indicators was entered, the achievement on the particular target indicator

was then rated and graded i.e. Red or grade 'D', Yellow or grade 'C', Blue or grade 'B' and Green

or grade 'A' (Table 3). The details are as indicated in Table 3. After the tool kit provides the scores,

it uses the following guidelines for rating.

Table 3: WBTi Guidelines Scores, Colour rating and Grading the IYCF Policies

and Programmes

Scores Colour- rating Grading

0 – 3 Red D

4 – 6 Yellow C

7 – 9 Blue B

more than 9 Green A

Once assessment of gaps was carried out and data verified, scoring and colour-rating was done for

each individual indicator as well as the entire set of indicators. For the indicators, the scores were

coded Red (Bad), Yellow (Insufficient), Blue (Needs improvement) and Green (Acceptable). The

performance of the country was colour coded through objective scoring for each achievement.

The tool kit uses the data that is fed into it, rates it into any colour i.e. Red , Yellow, Blue and

Green. The cut off points for each of these levels of achievement were selected systematically,

based on the WHO’s “Infant and Young Child Feeding: A tool for assessing national practices,

policies and programmes’’. WBTi used the key to rating of WHO’s tool.

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3.03.03.03.0 Assessment FindingsAssessment FindingsAssessment FindingsAssessment Findings

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Part 1: IYCF Policies and Programs Indicators

Indicator 1: National Policy, Programme and Coordination

Key question: Is there a national infant and young child feeding/breastfeeding policy that protects,

promotes and supports optimal infant and young child feeding and the policy is supported by a

government programme? Is there a mechanism to coordinate like National infant and young child

feeding committee and a coordinator for the committee ?

Criteria Scoring Results

1.1) A national infant and young child feeding/breastfeeding policy

has been officially adopted/approved by the government 1

1.2) The policy recommended exclusive breastfeeding for the first

six months, complementary feeding to be started after six months

and continued breastfeeding up to 2 years and beyond.

1

1.3) A national plan of action developed based on the policy* 2

1.4) The plan is adequately funded 2 0

1.5) There is a National Breastfeeding Committee/ IYCF

Committee** 1

1.6) The national breastfeeding (infant and young child feeding)

committee meets , monitors and reviews on a regular basis 2 0

1.7) The national breastfeeding (infant and young child feeding)

committee links effectively with all other sectors like health,

nutrition, information etc.

0.5 0

1.8) Breastfeeding Committee is headed by a coordinator with clear

terms of reference, regularly communicating national policy to

regional, district and community level.

0.5 0

Total Score 5/10

* Draft IYCF Roadmap was referred to

** Nutrition Technical Working Group serves the functions of the Breastfeeding Committee

Information Sources Used:

1. National Policy Guidelines on IYCF, 2012

2. Integrated ART /PMTCT and Infant Feeding Guidelines, 2012

3. Regulations on Marketing of Infants and Young Child foods, 1997

4. Guidelines on Management Structures, Ministry of Health, 2012

Conclusions:

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A national Infant and Young child feeding/breastfeeding policy has been officially adopted/approved

by the government. It recommends exclusive breastfeeding for the first six months, complementary

feeding to be started after six months and continued breastfeeding up to 2 years and beyond.

However, the national IYCF Policy Guidelines 2012 are not aligned to the 2010 WHO Guidance on

HIV and Infant Feeding. Use of regional and district based mentors help improve sense of

ownership of the IYCF programme. The MIYCF component is integrated in the partner plans.

Gaps:

1. There is no recognized core team for IYCF

2. The IYCF TWG does not link to other relevant sectors such as Agriculture, Labour and

Gender, etc

3. There is no official IYCF workplan

4. High staff turn-over of the trained health workers

Recommendations:

1. The Ministry of Health should constitute a multisectoral IYCF working core group that

reports to the Nutrition Technical Working Group. This committee can perform the same

functions as those stipulated for the Infant and Young Child Nutrition Committtee under

the Regulations on Marketing of Infant and Young Child Foods.

2. IYCF road map should be finalized and launched

3. The IYCF Policy Guidelines 2012 should be updated and aligned to the 2010 WHO

Guidance on HIV and Infant Feeding

4. Building the capacity VHTs on IYCF

5. Institutionalized training of health workers on IYCF

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Indicator 2: Baby Friendly Care and Baby-Friendly Hospital Initiative (16

Requirements to Successful Infant and Young Child Feeding)

Key questions:

• What percentage of hospitals and maternity facilities that provide maternity services have been

designated as “Baby Friendly” based on the global or national criteria?

• What is the quality of BFHI program implementation?

Guidelines – Quantitative Criteria

2.1) 11 out of 1,687 health facilities (both public & private )and maternity facilities offering

maternity services have been designated or reassessed as “Baby Friendly”in the last 5 years 0.1 %


0 0

0.1 - 20% 1

20.1 - 49% 2

49.1 - 69% 3

69.1-89 % 4

89.1 - 100% 5

Total rating 1 / 5

Guidelines – Qualitative Criteria

Quality of BFHI programme implementation:


2.2) BFHI programme relies on training of health workers

using at least 20 hours training programme1

1.0

2.3) A standard monitoring2 system is in place 0.5 0

1 IYCF training programmes such as IBFAN Asia’s ‘4 in1’ IYCF counseling training programme, WHO’s Breastfeeding

counseling course etc. may be used. 2 Monitoring is a dynamic system for data collection and review that can provide information on implementation of the

Ten Steps to assist with on-going management of the Initiative. It can be organized by the hospitals themselves or at a

higher level in the system. Data should be collected either on an ongoing basis or periodically, for example on a semi-

annual or yearly basis, to measure both breastfeeding support provided by the hospitals and mothers’ feeding practices.

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2.4) An assessment system includes interviews of health

care personnel in maternity and post natal facilities

0.5

2.5) An assessment system relies on interviews of

mothers.

0.5

2.6) Reassessment3 systems have been incorporated in

national plans with a time bound implementation

1.0 0

2.7) There is/was a time-bound program to increase the

number of BFHI institutions in the country

0.5 0

2.8) HIV is integrated to BFHI programme 0.5

2.9) National criteria are fully implementing Global BFHI

criteria

0.5

Total Score 3/5 3

Total Score 4/10


1. External BFHI assessment reports

2. BFHI training course

3. Health Sector Strategic Plan (HSSP) III

Conclusions:

BFHI Guidelines and Training Packages exist and have been recently updated; Tools for monitoring

and assessment are also available and have been revised. Much as the country has embraced the

BFHI approach as a means of improving the IYCF practices, implementation has been limited to few

areas where there is partner support. Besides the quality of BFHI implementation has been

compromised by lack of commitment from the health workers, coupled with weak monitoring and

supervision.

Gaps:

1. Health facilities recommended for designation as Baby Friendly have not been designated

2. There is no routine monitoring plan for BFHI

3. There is no time bound programme to increase the number of BFHI institutions

4. Reassessments have not been incorporated into the National plan

Recommendations:

3 Reassessment can be described as a “re-evaluation” of already designated baby-friendly hospitals to determine if they

continue to adhere to the Ten Steps and other babyfriendly criteria. It is usually planned and scheduled by the national

authority responsible for BFHI for the purpose of evaluating on-going compliance with the Global Criteria and includes

a reassessment visit by an outside team.Because of the human and financial resources required, in many countries it may

be feasible to reassess hospitals only once every three years, but the final decision concerning how often reassessment is

required should be left to the national authority.

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1. The Ministry of Health should take steps to ensure designation of health facilities that were

recommended in the External Assessment Reports.

2. The Ministry of Health should finalise and launch the MIYCF road map that incorporates

routine monitoring of BFHI, has a time bound programme to increase the number of BFHI

institutions, and incorporates BFHI reassessment into the national plan

3. The Ministry of Health should incorporate BFHI Assessment as part of the MoH Quality

Assurance Programme

4. Advocacy and sensitization of District Local Governments and other stakeholders to

support BFHI

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Indicator 3: Implementation of the International Code of Marketing of

Breastmilk Substitutes (National Regulations on Marketing of

Infant and Young Child Foods)

Key question: Is the International Code of Marketing of Breastmilk Substitutes and subsequent

WHA resolution in effect and implemented? Has any new action been taken to give effect to the

provisions of the Code?

Criteria

(Legal Measures that are in Place in the Country) Scoring Results

3a: Status of the International Code of Marketing

3.1 No action taken 0

3.2 The best approach is being considered 0.5

3.3 National Measures awaiting approval (for not more than three years) 1

3.4 Few Code provisions as voluntary measure 1.5

3.5 All Code provisions as a voluntary measure 2

3.6 Administrative directive/circular implementing the code in full or in part in

health facilities with administrative sanctions 3

3.7 Some articles of the Code as law 4

3.8 All articles of the Code as law 5

3.9 Relevant provisions of WHA resolutions subsequent to the Code are

included in the national legislation4

a) Provisions based on at least 2 of the WHA resolutions as listed below

are included

b) Provisions based on all 4 of the WHA resolutions as listed below are

included

5.5

6

3b: Implementation of the Code/National legislation

3.10 The measure/law provides for a monitoring system 1

3.11 The measure provides for penalties and fines to be imposed to violators 1

3.12 The compliance with the measure is monitored and violations reported to

concerned agencies 1 0

3.13 Violators of the law have been sanctioned during the last three years 1 0

Total Score (3a + 3b) 7.5/10

4 Following WHA resolutions should be included in the national legislation/enforced through legal orders to tick this score.

1. Donation of free or subsidized supplies of breastmilk substitutes are not allowed (WHA 47.5)

2. Labeling of complementary foods recommended, marketed or represented for use from 6 months onward (WHA 49.15)

3. Health and nutrition claims for products for infants and young children are prohibited (WHA 58.32)

4. Labels of covered products have warnings on the risks of intrinsic contamination and reflect the FAO/WHO

recommendations for safe preparation of powder infant formula (WHA 58.32, 61.20)

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1. Statutory Instruments Supplement No. 23 of 31st October 1997 to the Uganda Gazette No.

70 Volume XC: The Food and Drugs(Marketing of Infant and Young Child Foods)

Regulations, 1997.

2. WHA Resolutions 47.5, 49.15, 58.32, 61.20 that are relevant to the Code

Conclusions:

Aspects of the code that have been achieved are: all provisions of the original Code are captured in

the national legislation including WHA resolutions 47.5 and 49.15. The 1997 Regulations is

obsolete, and attempts to update it have been hampered by legalities.

Gaps:

1. Legislation does not cover the provisions of the WHA resolutions 58.32 and 61.20

2. Lack of enforcement of the Regulations and monitoring of violations.

3. The legislation is obsolete and the penalties it provides have become meaningless

Recommendations:

1. The Ministry of Health Nutrition Programme, Development partners and CSOs should

advocate for inclusion of The Regulations in the proposed Food and Medicines Act

2. Operationalise the monitoring and enforcement of the existing legislation

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Indicator 4: Maternity Protection

Key question: Is there a legislation and are there other measures (policies, regulations, practices)

that meet or go beyond the International Labor Organization (ILO) standards for protecting and

supporting breastfeeding for mothers, including those working mothers in the informal sector?


4.1) Women covered by the national legislation are allowed the following

weeks of paid maternity leave

a. Any leave less than 14 weeks

b. 14 to 17weeks

c. 18 to 25 weeks

d. 26 weeks or more

0.5

1

1.5

2

4.2) Women covered by the national legislation are allowed at least one

breastfeeding break or reduction of work hours daily.

a. Unpaid break

b. Paid break

0.5

1

0

0

4.3) Legislation obliges private sector employers of women in the

country to

a. Give at least 14 weeks paid maternity leave

b. Paid nursing breaks.

0.5

0.5

0

0

4.4) There is provision in national legislation that provides for work site

accommodation for breastfeeding and/or childcare in work places in the

formal sector.

a. Space for Breastfeeding/Breastmilk expression

b. Crèche

1

0.5

0

0

4.5) Women in informal/unorganized and agriculture sector are:

a. accorded some protective measures

b. accorded the same protection as women working in the

formal sector

0.5

1

4.6) . a. Information about maternity protection laws, regulations, or

policies is made available to workers.

b. There is a system for monitoring compliance and a way for

workers to complain if their entitlements are not provided.

0.5

0.5

0

4.7) Paternity leave is granted in public sector for at least 3 days. 0.5

4.8) Paternity leave is granted in the private sector for at least 3 days. 0.5

15


4.9) There is legislation providing health protection for pregnant and

breastfeeding workers: they are informed about hazardous conditions in

the workplace and provided alternative work at the same wage until they

are no longer pregnant or breastfeeding.

0.5

0

4.10) There is legislation prohibiting employment discrimination and

assuring job protection for women workers during breastfeeding period. 1

Total Score: 3.5/10


1. Employment Act of 2006

2. Labour Department Form 1(Check list)

3. Interviews with Principal Labour Officer/Productivity, Ministry of Gender

4. Director for Women and Youth, National Organisation of Trade Unions (NOTU)

Conclusions:

The Employment Act provides for Paternity and Maternity leave, although the maternity leave is

short of the ILO recommendation of 14 weeks

Gaps:

1. Maternity leave of 12 weeks does not measure up to the ILO recommendation of 14 weeks

2. There are no guidelines or regulations to operationalize the Employment Act

3. The ILO Convention 183 of 2000 has not been ratified by the Country

4. There is lack of awareness about maternity protection in the both formal and informal

sectors.

Recommendations:

1. The Department of Labour in the Ministry of Gender, Labour and Social Development

should take lead to ensure that the country ratifies the ILO Convention 183 of 2000


should take lead to ensure that Guidelines/Regulations are developed for Part 6 of the

Employment Act 2006

3. Advocacy and Social mobilization is required to bring together all stakeholders to promote

maternity and paternity protection.

4. Strengthen awareness on maternity protection

16

Indicator 5: Health and Nutrition Care Systems (in support of

breastfeeding & IYCF)

Key question: Do care providers in these systems undergo skills training, and do their pre-service

education curriculum support optimal infant and young child feeding; do these services support

mother and breastfeeding friendly birth practices, do the policies of health care services support

mothers and children, and whether health workers responsibilities to Code are in place?

Criteria

Scoring

Adequate Inadequate No

Reference

5.1) A review of health provider schools and pre-service

education programmes for health professionals, social and

community workers in the country5 indicates that infant

and young child feeding curricula or session plans are

adequate/inadequate

2 1 0

5.2) Standards and guidelines for mother-friendly childbirth

procedures and support have been developed and

disseminated to all facilities and personnel providing

maternity care. (See Annex 5b Example of criteria for mother-

friendly care)

2 1 0

5.3) There are in-service training programmes providing

knowledge and skills related to infant and young child

feeding for relevant health/nutrition care providers.6

2 1 0

5.4) Health workers are trained on their responsibility

under the Code implementation / national regulation

throughout the country.

1 0.5 0

5.5) Infant and young child feeding information and skills

are integrated, as appropriate, into training programmes

focusing on (diarrheal disease, acute respiratory infection,

IMCI, well-child care, family planning, nutrition, the Code,

HIV/AIDS, breast cancer, women’s health, NCDs etc.)

1 0.5 0

5.6) In-service training programmes referenced in 5.5 are 1 0.5 0

5 Types of schools and education programmes that should have curricula related to infant and young child feeding may vary from

country to country. Which departments within various schools are responsible for teaching various topics may also vary. The

assessment team should decide which schools and departments are most essential to include in the review, with guidance from

educational experts on infant and young child feeding, as necessary.

6 The types of health providers that should receive training may vary from country to country, but should include providers that care

for mothers and children in fields such as medicine, nursing, midwifery, nutrition and public health.

17

Criteria

Scoring

Adequate Inadequate No

Reference

being provided throughout the country.7

5.7) Child health policies provide for mothers and babies

to stay together when one of them is sick.

1 0.5 0

Total Score: 6/10


1. Curriculum Training Agenda for Makerere Medical School

2. Curriculum Training Agenda for Nurse/Midwifery School

3. BFHI Training Package

4. Integrated Management of Childhood Illnesses Manual

5. Helping Babies Breath (HBB+) Curriculum

6. Policy Guidelines for Infant and Young Child Feeding 2012

7. Interviews with Tutors and Lecturers

8. IMAM Guidelines, February 2015

9. Curriculum for Diploma in Mental Health Nursing (MHN) (Direct) Program, July 2007

Conclusions:

The inservice training packages deal with IYCF knowledge and skills adequately. The preservice

packages do not adequately address IYCF and have no concrete plans for skills acquisition. Attemts

have been made by the Ministry of Education, Sports, Science and Technology to incorporate IYCF

into Primary and Secondary school syllabus. Some Universities and tertiary institutions are offering

nutrition courses which cover some components of IYCF. Drama and Science Fair that focus on

IYCF are being encouraged by some primary and secondary schools.

Gaps:

1. Curicula in the health training institutions do not specify IYCF topics

2. Skills development in the preservice training curriculum is inadequate

3. Coverage for inservice training programmes is very low

Recommendations:

1. Ministry of Education, Sports, Science and Technology in collaboration with the Ministry of

Health Nutrition Programme should ensure that IYCF knowledge and skills training are

integrated into the curricula of Tutors and lecturers in the health training institutions

2. IYCF should be included in teaching schedules/agendas of all the health training institutions

7 Training programmes can be considered to be provided “throughout the country” if there is at least one training programme in each region or

province or similar jurisdiction.

18

Indicator 6: Mother Support and Community Outreach - Community-based

support for the pregnant and breastfeeding mother

Key question: Are there mother support and community outreach systems in place to protect,

promote and support optimal infant and young child feeding .

Criteria

Scoring

Yes

To some

degree

No

6.1) All pregnant women have access to community-based

ante-natal and post -natal support systems with counseling

services on infant and young child feeding.

2 1 0

6.2) All women recieve support for infant and young child

feeding at birth for breastfeeding initiation.

2 1 0

6.3) All women have access to counseling support for Infant

and young child feeding counseling and support services have

national coverage.

2 1 0

6.4) Community-based counseling through Mother Support

Groups (MSG) and support services for the pregnant and

breastfeeding woman are integrated into an overall infant and

young child health and development policy

IYCF/Health/Nutrition Policy.

2 1 0

6.5) Community-based volunteers and health workers are

trained in counseling skills for infant and young child feeding. 2 1 0

Total Score: 6/10


1. Interview with Principal Community Development Officer, MOGLSD; Nursing Officer,

Mulago National referral Hospital, Mother Support Group; Nutritionist, Feed the Children

Uganda

2. Policy Guidelines on Infant and Young Child Feeding 2012

3. Uganda Nutrition Action Plan 2011-2016

4. Training Package on Community Nutrition

5. PD Hearth Guidelines and Training Package

6. NACs Training Package

7. IMAM Guidelines and Training Package

19

Conclusions:

Relevant sector Policies incorporate community structures and clearly stipulate their roles and

responsibilities. An integrated training package for community volunteers covering some key

sectors has been developed

Community structures are in place, and in a few places capacities have been built.

Gaps:

1. Few community based volunteers have been trained on counselling and support to mothers

on isues of IYCF

2. Support supervision for community structures is inadequate

3. Support and funding for community structures on IYCF are mainly donor driven

4. Monitoring of Community IYCF interventions is very weak.

Recommendations:

1. Central and Local governments and partners should allocate more resources to cater for

the community component on IYCF

2. Regular review meetings that can be used to monitor performance at various levels

3. Strengthen the capacity of existing community structures on IYCF

4. Advocate for the VHT structure to be mainstreamed into the local government system

20

Indicator 7: Information Support

Key question: Are comprehensive Information, Education and Communication (IEC) strategies for

improving infant and young child feeding (breastfeeding and complementary feeding) being

implemented?

Criteria

Scoring

Yes To some degree

No

7.1) There is a national IEC strategy for improving infant and young

child feeding that ensures all information and materials are free from

commercial influence/ potential conflicts or interest are avoided.

2 0 0

7.2a) National health/nutrition systems include individual counseling on

infant and young child feeding

1 .5 0

7.2b) National health/nutrition systems include group education and

counseling services on infant and young child feeding

1 .5 0

7.3) IYCF IEC materials are objective, consistent and in line with

national and/or international recommendations and include

information on the risks of artificial feeding

2 1 0

7.4. IEC programmes (eg World Breastfeeding Week) that include

infant and young child feeding are being implemented at local level and

are free from commercial influence

2 1 0

7.5 IEC materials/messages to include information on the risks of

artificial feeding in line with WHO/FAO Guidelines on preparation

and handling of powdered infant formula (PIF).8

2 0 0

Total Score: 5/10


1. Nutrition Communication Strategy and Mobilisation Handbook

2. Division of Health Promotion and Education at Ministry of Health

3. Integrated Antenatal and Postnatal register

4. Nutrition and HIV Communication Strategy

Conclusions:

8 to ensure that clinicians and other health-care personnel, community health workers and families, parents and other

caregivers, particularly of infants at high risk, are provided with enough information and training by health-care

providers, in a timely manner on the preparation, use and handling of powdered infant formula in order to minimize

health hazards; are informed that powdered infant formula may contain pathogenic microorganisms and must be prepared

and used appropriately; and, where applicable, that this information is conveyed through an explicit warning on

packaging;

21

Individual counseling on IYCF is promoted; Group counseling and Education on IYCF is available;

Available IYCF IEC materials are appropriate. IEC programmes (eg World Breastfeeding Week)

that include infant and young child feeding are not being implemented in most districts. Nutrition

Communication Strategy and Mobilisation Handbook has been finalized and will soon be launched.

Gaps:

1. IEC programmes such as World Breastfeeding Week (WBW) are limited in scope and

geographic coverage

2. There are no IEC materials on risks of artificial feeding

Recommendations:

1. IEC programmes should be scaled up to cover the whole country

2. The Ministry of Health and partners should develop IEC materials on the risks of artificial

feeding

22

Indicator 8: Infant Feeding and HIV

Key question: Are policies and programmes in place to ensure that HIV - positive mothers are

supported to carry out the national recommended Infant feeding practice?

Criteria

Results

Yes To some degree

No

8.1) The country has a comprehensive updated policy in line with

international Guidelines on infant and young child feeding that includes

infant feeding and HIV

2 1 0

8.2) The infantfeeding and HIV policy gives effect to the International Code/

National Legislation

1 0.5 0

8.3) Health staff and community workers receive training on HIV and infant

feeding policies, the risks associated with various feeding options for infants

of HIV-positive mothers and how to provide counselling and support.

1 0.5 0

8.4) HIV Testing and Counselling (HTC)/ Provider Initiated HIV Testing and

Counselling (PIHTC)/ Voluntary and Confidential Counselling and Testing

(VCCT) is available and offered routinely to couples who are considering

pregnancy and to pregnant women and their partners.

1 0.5 0

8.5) Infant feeding counselling in line with current international

recommendations and appropriate to local circumstances is provided to

HIV positive mothers.

1 0.5 0

8.6) Mothers are supported in carrying out the recommended national

infant feeding practices with further counselling and follow-up to make

implementation of these practices feasible.

1 0.5 0

8.7) HIV positive breastfeeding mothers, who are supported through

provision of ARVs in line with the national recommendations, are followed

up and supported to ensure their adherence to ARVs uptake.

1 0.5 0

8.8) Special efforts are made to counter misinformation on HIV and infant

feeding and to promote, protect and support 6 months of exclusive

breastfeeding and continued breastfeeding in the general population.

1 0.5 0

8.9) On-going monitoring is in place to determine the effects of

interventions to prevent HIV transmission through breastfeeding on infant

feeding practices and overall health outcomes for mothers and infants,

including those who are HIV negative or of unknown status.

1 0.5 0

Total Score: 9/10

23


1. Integrated ART/PMTCT and IYCF Guidelines, 2012

2. National IYCF Policy Guidelines, 2012

3. Early Infant Diagnosis(EID) Registers

4. ART Client Cards

Conclusions:

Overall, Infant Feeding in the context of HIV is well catered for both in terms of policies and

programs. However, there is need to review the IYCF guidelines to align it with the WHO

recommendations taking into consideration the local context.

Integration of IYCF and maternal nutrition has improved nutrition assessments and referral from

ANC, YCC and OPD.

Gaps :

1. Some components of the WHO recommendations are not well addressed in the national

IYCF policy Guidelines.

Recommendations:

1. The national IYCF Policy guidelines should be reviewed to align it with the WHO

recommendations taking into consideration the local context

24

Indicator 9: Infant and Young Child Feeding during Emergencies

Key question: Are appropriate policies and programmes in place to ensure that mothers, infants and

young children will be provided adequate protection and support for appropriate feeding during

emergencies?

Criteria

Scoring

Yes To some degree

No

9.1) The country has a comprehensive policy on infant and young child

feeding that includes infant feeding in emergencies and contains all basic

elements included in the IFE Operational Guidance

2 1 0

9.2) Person(s) tasked with responsibility for national coordination with

all relevant partners such as the UN, donors, military and NGOs

regarding infant and young child feeding in emergency situations have

been appointed

2 1 0

9.3) An emergency preparedness and response plan based on the

practical steps listed in the Operational Guidance has been developed

and put into effect in most recent emergency situations, and covers:

a) basic and technical interventions to create an enabling

environement for breastfeeding, including counseling by

appropriately trained counselors, support for relactation and

wet-nursing, and protected spaces for breastfeeding

b) measures to minimize the risks of artificial feeding, including an

endorsed statement on avoidance of donations of breastmilk

substitutes, bottles and teats, and standard procedures for

handling unsollicited donations, and procurement management

and use of any infant formula and BMS, in accordance with

strict criteria, the IFE Operational Guidance, and the

International Code and subsequent relevant WHA resolutions

1 0.5 0

1 0.5 0

9.4) Resources have been allocated for implementation of the

emergency preparedness and response plan

2 1 0

9.5)

a) Appropriate orientation and training material on infant and young

child feeding in emergencies has been integrated into pre-service and

in-service training for emergency management and relevant health care

personnel.

b) Orientation and training is taking place as per the national

emergency preparedness and response plan

1 0.5 0

1 0.5 0

Total Score: 7/10

25


1. Policy Guidelines on Infant and Young Child Feeding 2012

2. OPM Department of Relief, Disaster Preparedness, and Management

3. Emergency Field Handbook, A guide for UNICEF Staff, July 2005

Conclusions :

Policy guidelines on IYCF cover issues of feeding in emergencies. National and district task forces

on emergency preparedness and response are available. Partners and donor agencies are available

to support emergencies

Gaps:

1. Measures to minimize the risk of artificial feeding in emergencies are inadequate

2. IYCF during emergencies has not been integrated in the pre and inservice national training

packages

3. Funding and support for IYCF in emergencies is mainly donor driven

Recommendations:

1. The Office of the Prime Minister and stakeholders should develop guidelines on IYCF in

emergencies to include measures that minimize risks of artificial feeding

2. Training schedules and agendas for health training institutions should be updated to include

issues of IYCF in emergencies

26

Indicator 10: Mechanisms of Monitoring and Evaluation System

Key question: Are monitoring and evaluation systems in place that routinely collect, analyse and use

data to improve infant and young child feeding practices?

Guidelines for scoring

Criteria Scoring

Yes

To some

degree No

10.1) Monitoring and evaluation components are built into

major infant and young child feeding programme activities.

2 1 0

10.2) Data/information on progress made in implementing

the IYCF programme are used by programme managers to

guide planning and investments decisions

2 1 0

10.3) Data on progress made in implementing IYCF

programme activities routinely collected at the sub national

and national levels

2 1 0

10.4) Data/Information related to infant and young child

feeding programme progress are reported to key decision-

makers

2 1 0

10.5) Monitoring of key infant and young child feeding

practices is integrated into the national nutritional

surveillance system, and/or health information system or

national health surveys.

2 1 0

Total Score: 6/10


1. HMIS Form 077: Integrated Nutrition Register

2. HMIS Form 105: Health Unit Outpatient Monthly Reporting Form

3. Uganda Demographic and Health Survey 2011

4. Nutrition and Food Security Surveillance Reports

5. Policy Guidelines on Infant and Young Child Feeding

6. Uganda Nutrition Action Plan 2011-2016

7. Ministry of Health HMIS Database

27

Conclusions:

Monitoring and evaluation components are built into major infant and young child feeding

programme activities such as BFHI, NACS, IMAM etc

Some of the IYCF indicators are captured into the HMIS and are being collected routinely at

subnational and national levels.

Gaps :

1. Use of data for planning is inadequate at all levels

2. Key decision makers have limited access to data on IYCF programmes

3. Monitoring of key infant and young child feeding practices is not adequately integrated into

the health information system

Recommendations:

1. The Ministry of Health should develop mechanisms for analysis, reporting back and use of

the collected information on IYCF programmes

2. The nutrition unit of Ministry of Health to share quarterly reports on IYCF indicators to the

Nutrition TWG and other stakeholders

28

Part II: IYCF Practices Indicators

Indicator 11: Early Initiation of Breastfeeding

Key question: What is the percentage of babies breastfed within one hour of birth? 52.5%

Guideline:

Indicator 11 Key to rating adapted from

WHO tool (see Annex 11.1) IBFAN Asia Guideline for WBTi

Initiation of Breastfeeding

(within 1 hour)

Scores Colour-rating

0.1-29% 3 Red

29.1-49% 6 Yellow

49.1-89% 9 Blue

89.1-100% 10 Green

Data Source (including year): UDHS 2011

Summary Comments :

The data source for this indicator is not current

There are no other plausible sources of this information

29

Indicator 12: Exclusive Breastfeeding for the First Six Months

Key question: What is the percentage of babies 0<6 months of age exclusively breastfed9 in the last

24 hours? 63.2%

Guideline:

Indicator 12 Key to rating adapted from WHO

tool (see Annex 11.1) IBFAN Asia Guideline for WBTi

Exclusive

Breastfeeding (for

first 6 months)


0.1-11% 3 Red

11.1-49% 6 Yellow

49.1-89% 9 Blue

89.1-100% 10 Green


Summary Comments :

The data source for this indicator is not current and the methodology used over estimates

exclusive breastfeeding rates


9 Exclusive breastfeeding means the infant has received only breastmilk (from his/her mother or a wet nurse, or expressed breastmilk) and no other

liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines (2)

30

Indicator 13: Median Duration of Breastfeeding

Key question: Babies are breastfed for a median duration of how many months? 19.0 months

Guideline:

Indicator 13 Key to rating adapted from WHO tool IBFAN Asia Guideline for WBTi

Median

Duration of

Breastfeeding


0.1-18 Months 3 Red

18.1-20 ’’ 6 Yellow

20.1-22 ’’ 9 Blue

22.1- 24 or beyond ’’ 10 Green

Data Source:

UDHS 2011

Summary Comments :



31

Indicator 14: Bottle feeding

Key question: What percentage of breastfed babies 0-12 months of age, who are fed with any foods

or drinks (even breastmilk) from bottles? 22% (0-23 months)*

Guideline:

Indicator 14 Key to rating adapted from WHO tool IBFAN Asia Guideline for WBTi

Bottle Feeding

(0-12 months)


29.1-100% 3 Red

4.1-29% 6 Yellow

2.1-4% 9 Blue

0.1-2% 10 Green

*Disagregated data for 0-12 months was not accessed


Summary Comments :



32

Indicator 15: Complementary feeding - Introduction of solid, semi-solid or

soft foods

Key question: Percentage of breastfed babies receiving complementary foods at 6-8 months of age?

68%

Guideline

Indicator 15 WHO’s IBFAN Asia Guideline for WBTi

Complementary Feeding

(6-9 months)

Key to rating Scores Colour-rating

0.1-59% 3 Red

59.1-79% 6 Yellow

79.1-94% 9 Blue

94.1-100% 10 Green

Data Source:

UDHS 2011

Summary Comments :



33

Summary Part I: IYCF Policies and Programmes

Targets: Score (Out of 10)

11. National Policy, Programme and Coordination 5

12. Baby Friendly Hospital Initiative 4

13. Implementation of the International Code 7.5

14. Maternity Protection 3.5

15. Health and Nutrition Care Systems 6

16. Mother Support and Community Outreach 6

17. Information Support 5

18. Infant Feeding and HIV 9

19. Infant Feeding during Emergencies 7

20. Monitoring and Evaluation 6

Part 1: Total score 59

IBFAN Asia Guidelines for WBTi

Total score of infant and young child feeding policies and programmes (indicators 1-10) are

calculated out of 100.

Scores Colour- rating

0 – 30.9 Red

31 – 60.9 Yellow

61 – 90.9 Blue

91 – 100 Green

Conclusions:

Indicators on Infant feeding and HIV, Infant feeding in Emergencies show acceptable performance .

areas which require more emphasis are: National Policy, Programme and Coordination, Baby

Friendly Health Facility Initiative, Maternity Protection, Information Support and monitoring and

Evaluation. Whereas legislation on the Regulations/CODE exists, enforcement and monitoring are

practically weak.

34

Summary Part II: Infant and young child feeding (IYCF)

practices

IYCF Practice Result Score

Indicator 11 Starting Breastfeeding (Initiation) 52.5 % 9

Indicator 12 Exclusive Breastfeeding for first 6 months 63.2 % 9

Indicator 13 Median duration of Breastfeeding 19 months 6

Indicator 14 Bottle-feeding 22 % 6

Indicator 15 Complementary Feeding 68 % 6

Score Part II (Total) 36

IBFAN Asia Guidelines for WBTi

Total score of infant and young child feeding Practice (indicators 11-15) are calculated out of 50.

Conclusions :

Indicators on initiation within an hour and exclusive breastfeeding show acceptable performance,

although the method of data collection over estimates exclusive breastfeeding rates. Indictors on

bottle feeding, complementary feeding and median duration of breastfeeding show inadequate

performance.


0 – 15 Red

16 - 30 Yellow

31 - 45 Blue

46 – 50 Green

35

Total of Part I and Part II (indicator 1-15): IYCF Practices and Policies and

Programmes

Total score of infant and young child feeding practices, policies and programmes (indicators

1-15) are calculated out of 150. Countries are then rated as:

Scores Colour- rating

0 – 45.5 Red

46 – 90.5 Yellow

91 – 135.5 Blue

136 – 150 Green

36

Key Gaps

1. The IYCF TWG does not link to other relevant sectors such as Agriculture, labour and

gender, etc and does not have an official IYCF workplan

2. There is no routine monitoring plan for BFHI

3. Legislation does not cover the provisions of the WHA resolutions 58.32 and 61.20

4. Lack of monitoring and enforcement of violations

5. There are no guidelines or regulations to operationalize the Employment Act

6. The ILO Convention 183 of 2000 has not been ratified by the Country

7. IYCF skills development in the preservice training curriculum is inadequate

8. Few community based volunteers have been trained on counselling and support to mothers

on isues of IYCF and support supervision for community structures is inadequate

9. IEC strategy for IYCF has not been finalised

10. Measures to minimize the risk of artificial feeding in emergencies are inadequate

11. Key decision makers have limited access to data on IYCF programmes

12. Monitoring of key infant and young child feeding practices is not adequately integrated into

the health information system

Key Recommendations

1. The Ministry of Health should constitute a multisectoral IYCF working core group that

reports to the Nutrition Technical Working Group. This committee can perform the same

functions as those stipulated for the Infant and Young Child Nutrition Committtee under

the Regulations of Marketing of Infant and Young Child Foods.

2. IYCF road map should be finalized and launched

3. The IYCF Policy Guidelines 2012 should be updated and aligned to the 2010 WHO

Guidance on HIV and Infant Feeding

4. The legislations should be updated and included in the proposed Food Safety Act

5. Operationalise the monitoring and enforcement of the existing legislation


should take lead to ensure that the country ratifies the ILO Convention 183 of 2000 and

Guidelines/Regulations are developed for the Employment Act No. 6 of 2006

7. Training schedules and agendas for health training institutions should be updated to include

issues of IYCF including IYCF in emergencies

8. Government should allocate adequate resources to cater for community component on

IYCF

9. Ministry of Health and partners should finalise the IEC Strategy for IYCF that includes IYCF

during emergencies

10. The Ministry of Health and Partners should develop mechanisms for routine data collection,

analysis, reporting back and use of the collected information on IYCF programmes

37

AnnexesAnnexesAnnexesAnnexes

Annex 1: List of the partners for the assessment process

1. Ministry of Health (MoH)

2. Ministry of Gender, Labour and Social Development

3. Ministry of Agriculture, Animal Industry and Fisheries

4. Ministry of Education, Sports, Science and Technology

5. Office of the Prime Minister (OPM)

6. United Nations Children’s Emergency Fund (UNICEF)

7. World Health Organisation (WHO)

8. International Baby Food Action Network (IBFAN) Uganda

9. National Organisation of Trade Unions (NOTU)

10. Uganda Bureau of Statistics (UBOS)

11. Bishop Danstan Nsubuga Memorial Community Centre

12. Baylor Uganda

13. Food and Nutrition Technical Assistance (FANTA) 3

14. Strengthening Partnership Results Innovations in Nutrition Globally (SPRING)

15. Uganda AIDS Commission (UAC)

16. Elizabeth Glasier Paediatric AIDS Foundation (EGPAF)

17. World Food Programme (WFP)

18. Mulago National Referral Hospital (Department of Maternal and Child Health, Paediatrics

and Child Health, Nursing and Midwifery School)

uganda assessment report - · pdf file2.3 wbti indicators ... hmis health management...

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